Robotics may dominate the conversation in orthopedic surgery right now, but the technology’s actual footprint in ambulatory surgery centers doesn’t match the hype, according to R. Michael Meneghini, MD, founder and CEO of Indiana Orthopaedic Institute in Noblesville, Ind.
Dr. Meneghini has more than two decades of experience in hip and knee replacement, including outpatient joint replacement.
He shared his perspective with Becker’s on why the fiscal case for robotics in ASCs remains unproven, and what would actually need to change for that to shift.
The hype doesn’t match the data
“Everybody talks about [robotics] — it’s like AI right now,” Dr. Meneghini said. “There’s a whole lot of talk, but if you walk into a building, you don’t see it,” he said, explaining that the picture looks very different once you leave the hospital setting and step into an ASC.
Why ASCs can’t play the same capital game as hospitals
The financial reality for ASCs is fundamentally different from hospitals, according to Dr. Meneghini. “In an ambulatory surgery center, I have to run a business that is based on ASC facility rates, not hospital facility rates,” he said. “My margins, particularly when it comes to Medicare, are less” and heavily scrutinized.
Most ASCs don’t have large capital equipment budgets to begin with — what they buy tends to be the essentials, he said, “beds and lights and things.” Spending on a standalone robot simply isn’t realistic under that model.
But he noted the business model itself has shifted. Device companies have moved away from selling robots outright and toward embedding the cost in implant pricing instead.
Facilities can now get a robot at no direct cost if they commit to a sole-source implant agreement, typically requiring 90% of joint replacement cases to use that company’s implants for two to three years. “They phrase it differently for compliance reasons,” he said, “but that’s what it is.”
The catch, in his view, is that the cost doesn’t disappear — it just moves.
“Nothing in life is free,” he said.
He estimated the actual cost for a company to deploy a robot at around $150,000, compared to $50,000 to $80,000 for a full set of manual instrument trays for a hip or knee replacement.
“It all comes from the same bucket of money,” he said. Facilities end up choosing between lower-cost implants without a robot, or a robot bundled into implant pricing that’s been adjusted to cover it.
The bigger question: who’s actually asking for this?
For Dr. Meneghini, the more important question isn’t whether robotics can pencil out financially — it’s why the technology is being pushed in the first place.
“Is it the industry that knows the more robots they get out, the less instrument trays they’ll have to produce, and they’re actually making more money?” he asked. “Or is it the surgeons or the hospitals who are going to use the robot to market against one another for competitive advantage?”
He was direct about where he lands on the marketing question specifically: robotics functions largely as a competitive differentiator, independent of clinical outcomes. He described asking his own patients — he sees roughly 60 a week — how they found him, and occasionally being asked whether he uses a robot. When he asks where they heard that, he said, patients “sheepishly” admit they read it online. “The marketing boils away at that point,” he said. Younger surgeons, he added, are more likely to adopt robotics simply “so they can say yes, I’m doing it,” using it selectively rather than on every case.
He also pointed to a less-discussed industry incentive: robotics allows device companies to reduce reliance on sales representatives. “If they could get rid of their sales reps by replacing them with inexpensive tech reps, that is the goal,” he said, since tech reps cost far less than the commissions paid to sales staff.
Robots don’t add what people think they add
Dr. Meneghini pushed back on the idea that robotics offers something fundamentally new.
“Remember, all robots just sit on computer navigation,” he said. “There’s nothing magical about the robot. It’s the navigation that’s guiding you.” He noted that computer navigation has existed for roughly 20 years without the same level of attention, and that most robotic arms across competing device companies are built by the same manufacturer, Kuka. “This isn’t as elaborate as the marketing people would like us all to believe,” he said.
On the argument that robotics reduces long-term outliers and revision cases even without immediate benefit, Dr. Meneghini was skeptical, noting that outlier placements don’t necessarily correlate with worse outcomes to begin with. “There’s a bunch of research that shows the outliers do just as well,” he said.
What would actually justify the investment
Asked what data would change his view, Dr. Meneghini said the answer has to tie back to the value equation — quality over cost — with turnover time as a key factor.
“The more efficient you are, the less costly your procedure is,” he said, “and it’s not like Medicare and Anthem are telling us, ‘Hey, be more costly.'” With reimbursement under continued pressure, he said, any technology adopted has to move that needle directly rather than simply adding cost.
At his own vertically integrated practice and ASC, he said, the three largest line items are physician salaries, staff salaries, and supplies — including implants. Because implant costs already exceed every other expense category, any deal that lowers implant costs, robot included, is worth considering. But he set two conditions: the technology can’t slow down the case, and it can’t compromise outcomes.
“Anybody who says they’re time-equal with a robot is lying.” And until infection and outcomes data improve, he said he remains cautious.
A generational skill concern
Dr. Meneghini raised one additional concern that he said extends beyond ASC economics entirely: the effect robotic reliance is having on surgical training. As a fellowship trainer, he said he’s observed a marked decline in manual surgical skill among fellows and residents trained primarily on robotics. “They’re becoming dependent on robotics,” he said, adding that the shift became especially noticeable to him over the past 24 months. He said some incoming fellows have specifically sought out training programs that avoid robotics, precisely because they recognize the risk of losing that foundational skill. “It’s wild,” he said, “because they realize they’ve lost their value because the robot took it from them.”
Still, he said he views broader robotic adoption as inevitable. “I think it’s inevitable. I think it’ll be there,” he said — even as the fiscal and clinical case for it, in his view, remains unresolved.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
